Olecranon osteotomy wheeless textbook of orthopaedics. There is no consensus about the ideal surgical approach for orif of. The comparison of tricepsreflecting anconeus pedicle and. Indications for the different techniques are clearly explained, and practical aspects that allow safe and reproducible clinical outcomes are described. Thirtyfive patients with refractory posttraumatic elbow contracture who underwent an olecranon osteotomyfacilitated elbow release ofer procedure were included in the study. The purpose of this article is to describe a novel technique that releases posttraumatic elbow contractures through an olecranon osteotomy and report the outcomes. Extended olecranon osteotomy for revision total elbow arthroplasty article in techniques in shoulder and elbow surgery 161. The ibalance hto surgical technique starts with an instrument system highly specific to the ibalance implants that creates a safety envelope with lockedin retractors, allowing the surgeon to create all cuts safely and reproducibly, while significantly reducing chances of neurovascular injury and lateral hinge fractures. Surgical techniques of olecranon fractures sciencedirect. Satisfactory results were reported in the literature as the surgical approach and techniques for fixation with olecranon osteotomy had been. At each visit, anteroposterior and lateral radiographs were taken and assessed for the adequacy of the reduction, loosening of implant and progression of the union. In this approach, a v type of osteotomy is created at the mid portion of the olecranon through the region not covered by hyaline cartilage. Olecranon osteotomy approach for complex aoc fractures of. A new technique for olecranon osteotomy in the treatment.
The book provides stateoftheart information on implant design and detailed guidelinesincluding treatment algorithmson specific arthroplasty procedures for arthritis, fractures, chronic dislocations, and other disorders. Suture repair of simple transverse olecranon fractures and c. The patient is placed in the lateral decubitus position with the operative arm placed over an arm holder. Ao surgery reference is a resource for the management of fractures, based on current clinical principles, practices and available evidence. We describe a new technique whereby a precontoured olecranon plate is first fixed to the olecranon, and a gigli saw is used to perform the osteotomy while the plate is in place. The compact and lightweight device is easily attached to any or table clark rail and is ready for immediate use. The osteotomy is performed with osteotomes and then repaired with olecranon osteotomy david a. An olecranon osteotomy provides the best visualization of the articular surface in complex distal humeral fractures compared with tricepssparing or tricepssplitting approaches. Fehringer, md investigation performed at the department of orthopaedic surgery and rehabilitation, university of nebraska medical center, omaha, nebraska. Olecranon osteotomy is a commonly used method for obtaining adequate exposure of the articular surface in complex distal humeral fractures.
For complex intraarticular fractures type c, an olecranon osteotomy is preferred. It was quite difficult to dissect it and to get the perspective right. Disabilities associated with untreated olecranon fractures result from disruption of the extensor mechanism. Erpelding, md, adam mailander, otrl, robin high, mba, ma. The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra. Due to the wide spectrum of fracture patterns, no single method of.
Compiled by the world\u2019s leading authority on elbow surgery, chapters address the common conditions and complications encountered by orthopaedic surgeons of all levels but from the perspectives of master surgeons. Tension band wiring of simple transverse olecranon fractures results in a high reoperation rate due to hardware problems. Remove the drill sleeve and use the depth gauge to measure the screw length. An olecranon osteotomy provides a trap door through. It can be slightly curved to the radial side to protect the ulnar nerve. Strip the softtissue attachments off the mediolateral sides retract it proximally elevating the triceps posterior aspect of the distal end of the humerus is directly.
For mild deformities, a distal metatarsal osteotomy, such as a chevron osteotomy, is sufficient. This book provides cuttingedge information on surgical techniques for sports injuries of the elbow, highlighting key practical aspects. Technique using isoelastic tension band for treatment of olecranon fractures rebecca a. A surgical video demonstating technique of olecranon osteotomy for a distal humerus fracture. Locking screws are made of titanium alloy ti6a14v which is stronger than the pure titanium plate holes. When performing the olecranon osteotomy, remember that the semilunar notch is vshaped with the central area being the thickest the site for the osteotomyabout 2 cm distal to the olecranon tip 8. This technique is associated with a high complication rate and development of an extraarticular olecranon osteotomy may be advantageous. Olecranon osteotomy is a wellestablished technique, providing access to the distal humerus for reduction and fixation of intraarticular fractures. Surgical exposures of the elbow musculoskeletal key.
Clinical results of the refixation of a chevron olecranon. T1 technique of olecranon bone grafting for surgical fixation of scaphoid fractures. The olecranon osteotomyfacilitated elbow release ofer. Olecranon osteotomy w sled application in approach to. Drill and tap olecranon prior to performing the osteotomy.
Cadaveric dissection, implantation, osteotomy, and extraction of a total elbow arthroplasty were performed using an extended olecranon osteotomy. This video demonstrates our surgical approach to treating intraarticular distal humerus fractures as well as the use of the trimed olecranon sled for fixation of an olecranon osteotomy. The trimano fortis support arm acts as an additional surgical assistant by securely and safely holding the patients arm in any desired position during arthroscopic or open elbow surgery. Leaders in sports medicine offer guidance on everything from patient positioning and the latest surgical techniques through pearls and pitfalls and postoperative care. Be safe stay in the care of responsible adult the first 24 hours. They vary in complexity from relatively simple transverse fractures to highly comminuted and unstable fracture dislocations. Technique of olecranon bone grafting for surgical fixation.
Flex the elbow 90 degrees, reduce the fracture, and apply the plate. A successful functional outcome after olecranon fractures correlates directly with accuracy of anatomic joint reduction, restoration of mechanical stability that allows early motion, respect for the soft tissue. Chevronolecranon osteotomies are commonly used for the approach. A straight posterior incision is made longitudinally from approximately 8 cm proximal to the tip of the olecranon and 8 cm. Outcomes following distal humeral fracture fixation with an. Six patients 15% had accompanying fractures and two of them had concomitant head and thorax injury. Surgical techniques for trauma and sports related injuries of.
Tricepssparing extraarticular stepcut olecranon osteotomy. Distal humerus reconstruction with olecranon osteotomy. Double loop tension band techniques to the classic ao tension band technique for. Surgical technique a consistent technique, except for plate. Olecranon osteotomy for exposure of fractures and nonunions of. This paper describes a technique for olecranon osteotomy using an apex, distal, chevronshaped osteotomy, kirschner wires directed out the anterior ulnar cortex distal to the coronoid process and bent 180degrees and impacted into the olecranon proximally, and two 22 gauge, figureofeight, stainless steel tension wires. As for any orthopedic procedure, the choice of the surgical approach should be based on the following criteria. Olecranon fractures can be complex injuries presenting the treating physician with a wide array of surgical and nonsurgical options. The most popular variation of the olecranon osteotomy to date is that of the chevron osteotomy. Surgical treatment of comminuted intraarticular fractures of. The management of intraarticular distal humeral fractures remains a difficult surgical problem. A thorough knowledge of all anatomical structures is necessary to allow safe and practical surgical approaches to be made, and is crucial for understanding potential sites or. The apex distal chevron osteotomy was performed using an oscillating saw.
The wound was thoroughly irrigated with normal saline prior to fixation of the olecranon osteotomy. In the final analysis, the preferred treatment is that which addresses the needs of the specific patient. Although this common injury is frequently operated on, it has complications. The osteotomy entered the joint at the depth of the trochlear notch. Surgical treatment of intraarticular distal humeral fractures in adults. Determining the efficacy of screw and washer fixation as a method. Olecranon osteotomy facilitated elbow release ofer vumedi. Foot and ankle technique guide metatarsal shortening. Revision surgery of an olecranon fracture after initial surgical treatment failure in a. Materials and methods surgical technique the patient is placed in the lateral decubitus position with the arm supported as shown in figure 2. A concise and consistent chapter format makes it easy to. Erpelding, md, adam mailander, otrl, robin high, mba, ma, matthew a. Outcome of olecranon osteotomy in the transolecranon approach of intra articular fractures of the distal humerus cilt vol. All patients treated using an olecranon osteotomy exposure demonstrated.
Surgical techniques for trauma and sports related injuries of the. The prongs in the proximal end of the plate should penetrate the triceps tendon and provide provisional fixation. Outcomes following distal humeral fracture fixation with an extensor mechanismon approach jason m. This technique for extended olecranon osteotomy provides reliable, atraumatic access to the ulnar canal, cement mantle, and component for safe extraction of a wellfixed implant.
The osteotomy is fixed with a screw or tension band fixation. The best method of treatment for comminuted intraarticular fractures of the distal humerus has long been subject to debate, particularly when the fractures occur in. Morrey introduction few joints require familiarity with as many surgical exposures as does the elbow. Next, the guidewire that had previously been placed into the olecranon shaft, prior to making the osteotomy cut, was placed. A new technique for olecranon osteotomy in the treatment of distal. Use of orthogonal or parallel plating techniques to treat distal.
Selection of a particular osteotomy is also dependent on the surgeons familiarity and experience with the various surgical options. Create a chevron osteotomy with the apex pointing distally. Depending on the lesion and the surgical goal, the joint and the surrounding region may be approached from the lateral, posterior, medial, or anterior direction. Olecranon osteotomy w sled application in approach to distal humerus orif. Plate fixation of olecranon osteotomies request pdf. Olecrenon osteotomy identify dissect out the ulnar nerve if fixationof the olecranon osteotomy by screw, drill and tap the olecranon before the osteotomy is performed.
The following technique guide describes a metatarsal shortening technique using the hattrick osteotomy guide. A straight posterior longitudinal skin incision was used just lateral to the olecranon tip. Olecranon osteotomy end cap countersunk end cap for reduced soft tissue irritation and reoperations easy reattachment of olecranon single size. Extended olecranon osteotomy for revision total elbow.
The osteotomy configuration provides a large surface area for bony. Fractures of the olecranon process of the ulna are among the more common upper extremity fractures requiring operative intervention. Olecranon osteotomy w sled application in approach to distal. Evolution in implant design and surgical technique has led to improved. Controversies in the management of intraarticular fractures. The acumed osteotomy system features the ulna shortening plate which is designed to offer a lowprofile plate with builtin osteotomy reference lines and an osteotomy guide. For the common procedures, a number of surgical technique options are presented, ensuring that the reader gains a broader perspective on this evolving surgical field. Rigorous adherence to the principles of good surgical technique is of no greater importance in any anatomic part than at the elbow.
Thirtyfive patients with refractory posttraumatic elbow contracture who underwent an olecranon osteotomy facilitated elbow release ofer procedure were included in the. Biomechanical analysis of a novel plating for intraarticular distal humerus. The instruments also allow for alignment of the osteotomy to the. Although an olecranon osteotomy provides excellent exposure for management of these fractures, a number of complications can occur after the creation and repair of the osteotomy including nonunion, malunion. Jul 11, 2018 selection of a particular osteotomy is also dependent on the surgeons familiarity and experience with the various surgical options. An illustrative surgical case is also included with pertinent intraoperative and radiographic images. Written by the worlds foremost shoulder and elbow surgeons, this volume is the most comprehensive, current reference on shoulder and elbow arthroplasty. The osteotomy is performed with osteotomes and then repaired with a tension band technique. For simple fractures and osteotomies of the olecranon. May 01, 2000 the best method of treatment for comminuted intraarticular fractures of the distal humerus has long been subject to debate, particularly when the fractures occur in patients with osteoporosis. Outcome of olecranon osteotomy in the transolecranon. A posterior approach to the elbow utilizing an olecranon. Olecranon osteotomy this is the colour illustration of my self dissected specimen.
Diameter 6 mm, length 40 mm 2 synthes olecranon osteotomy nail technique guide. The surgical indication is marked displacement with rare exception for severe medical comorbidities. The reference lines on the plate help facilitate the creation of the osteotomy when a free hand cut is preferred. Suture repair of simple transverse olecranon fractures and. The commons is a showcase for jefferson books and journals. This reference offers a stepbystep, howto approach on performing both open and arthroscopic surgeries for sportsrelated injuries of the knee, elbow, and shoulder.
This technique is suitable for simple transverse olecranon fractures or olecranon osteotomy with stability of the ulnohumeral articulation. Outcomes following distal humeral fracture fixation with. The polyaxial locking technology works by using two different grades of titanium. The osteotomy is performed with osteotomes and then repaired. Orif of intercondylar fracture of humerus by olecranon osteotomy approach duration. Dec 04, 2019 olecranon fractures can be complex injuries presenting the treating physician with a wide array of surgical and non surgical options.
Surgical treatment of comminuted intraarticular fractures. Olecranon locking plate surgical techniquealog infor nota bene the technique description herein is made available to the healthcare professional to illustrate the authors suggested treatment for the uncomplicated procedure. The triceps reflecting approach bryanmorrey for distal humerus. Surgical techniques for trauma and sports related injuries. It is published in collaboration with isakos and will be of value to students, physiotherapists, sports physicians, and orthopaedic surgeons. When a screw is driven into a plate hole, the locking threads on the underside of the screw engage the circular lip in the hole. The olecranon was reduced and held using tenaculums.
Next, attention was directed toward repairing the olecranon osteotomy. The technique described in this report is technically straightforward and has a shorter learning curve than the chevron osteotomy. Mechanical evaluation of pin and tensionband wire factors in an. Surgical technique all patients were prepared in the supine position and tourniquet was applied. Although an olecranon osteotomy provides excellent exposure for management of these fractures, a. Olecranon osteotomy for exposure of fractures and nonunions. A technique using highstrength braided polyester and polyethylene suture through a bone tunnel has been piloted. Joint congruity and fixation could easily be assessed intraoperatively. Oct 01, 2014 orif of intercondylar fracture of humerus by olecranon osteotomy approach duration. Goulet kagan ozer introduction fractures of the olecranon constitute approximately 10% of fractures that occur about the elbow. It may not fully cool the elbow below the dressing, but it is still beneficial.
Attach the olecranon plate proximal targeting guide 800654 to the olecranon plate 7003xx with the locking bolt. Compiled by the worlds leading authority on elbow surgery, chapters address the common conditions and complications encountered by orthopaedic surgeons of all levels but from the perspectives of master surgeons. The proximal and distal extension of the exposure depends on the exposure needed and the type of osteotomy planned. We also demonstrate our intraoperative management of the ulnar nerve. Technique of olecranon bone grafting for surgical fixation of. Olecranon osteotomy and fixation by cancellous screw openi. Thirtyfive patients with refractory posttraumatic elbow contracture who underwent an olecranon osteotomyfacilitated elbow release ofer procedure were included in the. The associated functional limitations, including an inability to reach over the head or to push off, are substantial. The posterior approach through a chevron osteotomy of the olecranon is most often used and allows excellent visualisation of the distal humerus 3, 6. A study conducted in an olecranon osteotomy model showed that wire diameter is. For moderate and severe deformities, a midshaft or proximal osteotomy along with a phalangeal osteotomy may be. This chapter provides an overview of the surgical anatomy of the elbow. Transolecranon chevron osteotomies cos remain the gold standard surgical approach to type c fractures of the distal humerus.
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